MedicaidCoverageMedium impact
Breast Procedures - MEDICAID - OHIO (Revised)
Humana·OH · Plastic Surgery, General Surgery, Oncology·Medicaid
Effective date
Apr 10, 2026
We identified it
Jun 24, 2026
Summary
This is a new Medicaid policy for breast procedures in Ohio, covering breast reconstruction, reduction mammoplasty, and related procedures. The policy establishes coverage criteria including requirements for prior authorization and medical necessity documentation for specific breast surgery procedures.
Action Required
Before April 10, 2026: Billing team must review Ohio Medicaid Prior Authorization and Notification List for specific CPT and HCPCS codes requiring prior authorization for breast procedures. Update billing system to flag breast procedure codes for prior auth requirements. Ensure medical necessity documentation is submitted with all prior authorization requests for breast surgeries. Access Humana's physical health clinical coverage policies at the provided URL for detailed criteria.